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Li Shicai stated: The *Neijing* discusses headache, attributing it to wind, cold, and deficiency. The ten articles on headache in the Theory of Five Movements and Six Qi (Yunqi), and the one article on Taiyang headache in the *Shanghan Lun* (Treatise on Cold Damage), all describe how the Six Qi (Wind, Cold, Summer-heat, Dampness, Dryness, Fire) invade each other and contend with the True Qi (Zhenqi). This causes the Qi of the meridians to rebel and ascend, invading the clear orifices, preventing normal circulation, leading to stagnation and obstruction, resulting in pain. The head is like the sky; the Clear Yang Qi of the six Fu organs and the Essence-Blood of the five Zang organs all converge here. Therefore, the pathogenic factors of the Six Excesses (Liu Yin) from nature, and the variations of the Five Thieves (Wu Zei - referring to pathological emotional or internal changes) within the body, can both cause harm. They may obscure the clarity of the head, or block the meridians, contending with Qi, accumulating into heat, causing fullness in the vessels and pain. If pathogenic factors linger, vessels are full, and Qi and Blood are chaotic, the pain becomes severe; this is Excess Pain. When invaded by Cold-Dampness, if True Qi is weak, although there is no contention generating heat, the pathogen resides outside the vessels, causing blood to congeal and vessels to become cold. The vessels contract and tighten, pulling on the small collaterals externally, causing pain; warmth stops the pain. This is Deficiency Pain. Headache caused by Wind presents with twitching, pulling pain, and aversion to wind. Headache caused by Heat presents with vexation and aversion to heat. Headache caused by Dampness presents with heaviness in the head, worsening on cloudy days. Headache caused by Phlegm presents with dizziness, heaviness, and incessant nausea. Headache caused by Cold presents with contraction, tightness, aversion to cold, and shivering. Headache due to Qi Deficiency presents with aversion to labor and a large, forceless pulse. Headache due to Blood Deficiency presents with easily startled anxiety and a Kou (hollow) pulse.

Headaches have many causes, yet ancient formulas often use Wind-dispersing herbs. This is because at the high peak of the head, only Wind herbs can reach. Herbs with thin flavors belong to Yin transforming into Yang, rising from earth to heaven. For headaches caused by Wind, Cold, and Dampness, this is indeed the correct treatment; even for Deficiency and Heat patterns, they are used as guiding herbs to direct medicinal action upwards.

It must be known that acute and sudden onset is merely called "headache"; deep-seated and chronic cases are called "head wind" (Toufeng). Head wind inevitably damages the eyes, as the classic states: "East wind arises in Spring, disease affects the Liver." The eyes are the orifice of the Liver; when Liver Wind moves, pathogens侵害 the empty orifices.

Headache accompanied by dysfunction of the nine orifices belongs to Qi Deficiency; treat with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Shaoyao (Paeoniae Radix Alba), Chuanxiong (Chuanxiong Rhizoma), and Xixin (Asari Radix et Rhizoma). The area behind the eyebrow tip near the hairline is called "Fish Tail" (Yuwel); attacking pain here belongs to Blood Deficiency; treat with Siwu Tang (Four Substances Decoction) plus Bohe (Menthae Haplocalycis Herba). Headache worsened by movement indicates Stomach Heat; treat with Da Huang (Rhei Radix et Rhizoma) fried in wine, decocted in strong tea. Vexation combined with headache is treated with Qingkong Gao (Clear the Empty Orifice Paste) plus Maidong (Ophiopogonis Radix) and Danshen (Salviae Miltiorrhizae Radix et Rhizoma).

Zhang Sanxi said: The *Neijing* states, "All wind-induced tremors and vertigo belong to Liver Wood." In individuals who are Qi-deficient and obese with white complexion, Damp-Phlegm stagnates in the upper part, while Yin Fire rises from below. Thus, Phlegm carries Deficient Fire upward to the head and eyes. Because Righteous Qi is weak and cannot overcome the pathogen, sudden blackouts, visual spots, and rotational vertigo occur, as if sitting in a boat or carriage. In severe cases, sudden collapse and loss of consciousness may happen. This is what Zhu Danxi referred to as "No Phlegm, No Vertigo." However, in dark-skinned, thin individuals with weak constitutions, if True Water is deficient, or due to overwork, Ministerial Fire flares upward, they also experience frequent vertigo. Where is the Damp-Phlegm? Liu Wansu's *Yuanbing Shi* states: "Stillness and tranquility represent the transformation of Water; agitation and disturbance represent the function of Fire." The brain is generated by Earth Qi, storing Yin in the eyes as the pupil, governed by Kidney Water, the ultimate Yin. These two prefer stillness and dislike agitation. If tremors and vertigo occur, scattering and confusion result, leading to spinning of the brain and dizzy eyes. Treatment: For obese, fair-skinned individuals with vertigo, clear Phlegm, descend Fire, and supplement Yin. For dark, thin individuals, nourish Yin, descend Fire, and include herbs to suppress Liver. For vertigo caused by Wind Pathogens, dispel Wind, regulate Qi, and subdue Liver and descend Fire. Vertigo due to hematemesis is mostly due to Blood and Qi depletion, with Deficient Fire floating upward, similar to postpartum blood vertigo. Li Chan's *Yixue Zhunsheng* states: Whenever festivals or irregularities occur, Qi of the affected meridians and organs rises recklessly. Or, if Kidney Water is insufficient, or Essence and Blood are damaged, failing to control the solitary brilliance of the Five Yang Fires. Or, if Spleen-Stomach Earth is weak, failing to guard against rebellious Qi from below, then Dragon-Lei Fire vibrates at the crown. Various Fires ascending to the head cause mild rotational vertigo or severe beating pain.

Xue Lizhai stated: Regarding head and eye vertigo, Mr. Zhu Danxi said: "Vertigo refers to black rotational dizziness, characterized by closed eyes and dim vision, body rotation, deafness, feeling like standing on a vehicle, and wanting to fall when standing up." This is generally due to extreme deficiency compounded by Cold. However, treatment should not follow a single path. If caused by Wind, there is sweating; by Cold, pulling pain; by Summer-heat, heat and stifling; by Dampness, heaviness and stagnation. These four pathogens cause vertigo when exploiting deficiency. If caused by stagnation generating Phlegm, it is due to Kidney Deficiency where Qi does not return to its source. If caused by vomiting blood, epistaxis, or metrorrhagia, it is Yuan Qi Deficiency; administer Zhengyuan Yin with Heixi Dan (Black Tin Pill). For dampness-induced dizziness, use Shen Zhuo Tang plus Chuanxiong. For Phlegm, use Qingzhou Bai Wanzi (Qingzhou White Pills). Head wind is Wind-Heat; long-term leads to blurred vision. Hemilateral head wind is Ministerial Fire; long-term leads to tight eyes and urinary difficulty. Bleeding is suitable to open the exterior. I suggest: Liver-Deficiency dizziness uses Gouteng San; Kidney-Deficiency dizziness uses Liuwei Wan (Six-Ingredient Pill with Rehmannia). Dizziness with phlegm expectoration uses Yangzheng Dan; if ineffective, Bayi Wan (Eight-Ingredient Pill). Blood-Deficiency dizziness uses Siwu Tang plus Renshen, Cangzhu, Baizhu; if ineffective, Danggui Buxue Tang. Qi-Deficiency dizziness uses Sijunzi Tang plus Danggui; if ineffective, Buzhong Yiqi Tang. Liver-Fire Excess uses Xieqing Wan; Deficiency uses Dihuang Wan; if ineffective, Chuanxiong San. Spleen-Qi Deficiency uses Erchen Tang plus Renshen, Baizhu, Chaihu, Shengma; if ineffective, Yiqi Tang plus Fuling, Banxia. Spleen-Stomach Phlegm uses Banxia Baizhu Tianma Tang. Wind-Phlegm surging upward uses Sishen San. Fever and aversion to cold uses Bawu Tang. Seven Emotions Qi rebellion uses Siqi Tang. Cold damage with vertigo uses Chushi Tang.

Zhu Danxi said: Head vertigo is Phlegm combined with Qi Deficiency and Fire. Treatment focuses on resolving Phlegm, supplemented by Qi-tonifying and Fire-descending herbs. Without Phlegm, there is no vertigo. A rapid pulse on the left indicates excess Heat; sluggishness suggests fixed Blood. A solid pulse on the right indicates Phlegm accumulation; a large pulse indicates chronic illness. Qi and Blood both deficient with a large pulse indicates turbid Phlegm failing to descend.

Headache is mostly due to Phlegm; severe pain is mostly due to Fire. Some cases can be treated with emesis or purgation. Chuanxiong can be used for headache. If ineffective, add guiding herbs according to the meridian: Taiyang uses Chuanxiong; Yangming uses Baizhi; Shaoyang uses Chaihu; Taiyin uses Cangzhu; Shaoyin uses Xixin; Jueyin uses Wuzhuyu. Obese individuals have Damp-Phlegm; use Banxia, Cangzhu. Thin individuals have Heat; use wine-processed Huangqin, Fangfeng. Common cold headache uses Qianghuo, Gaoben, Baizhi. Wind-Heat above uses Tianma, Manjingzi, Taixiong, wine-Huangqin. Obese, fair-skinned individuals have Qi Deficiency; use Renshen, Shengdi, Nanxing, Micang Anshen Tang. Thin, dark-complexioned individuals have Blood Deficiency; use Chuanxiong, Danggui, wine-Huangqin. For severe headache, use Xixin. Vertex pain uses Gaoben, Fangfeng, Chaihu. For example, Taiyang headache with aversion to wind and floating-tight pulse uses Chuanxiong, Qianghuo, Duhuo, Mahuang as main herbs. Shaoyang headache with wiry-thin pulse and alternating chills and fever uses Chaihu as main herb. Yangming headache with spontaneous sweating, fever, aversion to cold, and floating-slow-long-solid pulse uses Shengma, Gegen, Shigao, Baizhi as main herbs. Taiyin headache involves Phlegm, heavy body, or intestinal pain, with sinking-slow pulse; use Cangzhu, Banxia, Nanxing as main herbs. Shaoyin headache with cold feet and rebellious Qi (Cold Jue) and sinking-thin pulse uses Mahuang, Fuzi, Xixin as main herbs. Jueyin headache with spitting of frothy phlegm, cold limbs, and floating-slow pulse is primarily treated with Wuzhuyu Tang. Blood-Deficiency headache uses Chuanxiong, Danggui as main herbs. Qi-Deficiency headache uses Renshen, Huangqi as main herbs. Combined Qi and Blood Deficiency headache uses Tiaozhong Yiqi Tang added with Chuanxiong, Manjingzi, Xixin; efficacy is miraculous.

Head wind is mostly due to Phlegm, involving Heat, Wind, or Blood Deficiency. On the left, it is Wind; use Bohe, Jingjie. Blood Deficiency; use Chuanxiong, Danggui. On the right, it is Phlegm; use Cangzhu, Banxia. Heat; use wine-Huangqin as main herb. Additionally, Damp-Phlegm; use Chuanxiong, Nanxing, Cangzhu. Hemilateral head wind on the left due to Wind uses Jingjie, Bohe; these two are supreme remedies. One must observe accompanying symptoms to add assistants. If Phlegm exists, use Erchen Tang to resolve Phlegm as an assistant. Recognizing the condition relies entirely on flexible methods.

Wang Haizang stated: Head sweating stopping at the neck is a Blood syndrome. Why is forehead sweating predominant? The head is the convergence of the Six Yang meridians, so heat steams and causes head sweating. Forehead predominance is determined by location: left cheek belongs to Liver, right cheek to Lung, nose to Central Region (Spleen), chin to Kidney, forehead to Heart. Sanjiao Fire depletes Kidney Water; residual water from channels is forced upward into the Heart region, causing head sweating. Forehead predominance belongs to the Heart region and is a Blood syndrome. Head sweating after drinking alcohol or eating is also a Blood syndrome.

Regarding miscellaneous diseases, if Ministerial Fire forces Kidney Water upward into the Heart, causing night sweats or spontaneous sweats, which transmit to head sweating, or epigastric fullness, all are treated according to Blood syndrome protocols, regardless of Cold Damage or miscellaneous diseases.

Epigastric fullness after purging alcoholic accumulation is a Blood syndrome. Why? Purging causes loss of Yin. Loss of Yin damages Spleen-Stomach and leads to loss of Blood. Qi in the chest, having lost Blood, sinks into the Heart region, causing epigastric fullness. People mistakenly think it is a Blood disease and use Qi-regulating drugs, worsening the fullness. Further purging leads to abdominal distension. This is incorrect treatment. Only tonifying the Central Spleen Earth and treating with Blood herbs is optimal.

Wang Jiezhai stated: Chronic headache triggered by slight Wind-Cold exposure, requiring thick wrapping in winter, belongs to Depressed Heat, with Heat as the root and Cold as the branch. Laypeople do not understand this and usually use acrid-warm dispersing agents. Temporary relief leads to misdiagnosis as Cold. However, because there is underlying Depressed Heat and loose pores, Wind-Cold enters easily. External Cold binds internal Heat, causing obstruction and pain. Acrid-hot drugs can open obstruction and disperse superficial Cold, but using heat to aid heat deepens the root disease and worsens aversion to cold. Treatment should focus on draining Fire and cooling Blood, assisted by acrid-warm exterior-dispersing agents. Following this method cures the disease and removes the root.

Dai Yuanli stated: Head wind vertigo should not be dismissed as non-Wind just because it is not painful. Careful examination is essential; do not hastily treat as Deficiency. Tonics will worsen it. If there are no other diseases or post-illness conditions, and this occurs suddenly, it is clearly Wind Vertigo. Treat with Xiao Xuming Tang plus Quanxie (Scorpio) 3-4 pieces.

Orbital bone pain has two syndromes: Liver Deficiency pain, severe upon seeing light, treat with Shengshu Dihuang Wan. Liver Meridian Fluid Retention, causing brow bone pain, inability to open eyes, quiet by day and worse by night, treat with Daotan Yin, or Xiongin Tang removing tea buds, or Erchen Tang swallowing Qingzhou Bai Wanzi.

Zhang Jiebin stated: Headache requires assessing duration first, then distinguishing Exterior/Interior. Acute pain is due to pathogens; chronic pain involves Yuan Qi. Acute pain with Exterior pathogens requires dispersion; avoid descending/clearing. Interior pathogens require clearing/descending; avoid ascending/dispersing. Chronic pain comes and goes, or is triggered by slight Exterior deficiency, slight Heat (Yang excess), Lower Water deficiency with Deficient Fire, or Upper Yang deficiency with Cold dominance. Focus on Yuan Qi. This is the general principle. Acute illness can be Deficient; chronic illness can be Excess; distinguish by pulse and symptoms.

Fire Pathogen pain occurs in all meridians, most commonly Yangming. Without Exterior pathogens, use Baihu Tang plus Shengdi, Maidong, Mutong, Zexie. Other meridians use Huangqin, Huanglian, Zhimu, Huangbai. Treating Fire should not assist with ascending/dispersing herbs. Exterior Fire can be dispersed; Internal Depressed Fire becomes fiercer with ascending herbs.

Zhang Jingyue stated: Regarding vertigo, Hejian cites *Neijing*: "All wind tremors and vertigo belong to Liver." Danxi says: "Phlegm above, Fire below; Fire flares up moving Phlegm; without Phlegm, no vertigo." Based on these, vertigo is Wind, Fire, or Phlegm. However, Xuandi never mentioned Phlegm for fluid disorders, only stating "Upper Qi insufficiency causes head tilting and eye vertigo"; "Upper Deficiency causes vertigo"; "Du Mai Deficiency causes heavy head and shaking"; "Marrow Sea insufficiency causes brain spinning, tinnitus, and vertigo." Are all these Phlegm syndromes? Danxi says no Phlegm, no vertigo; I say no Deficiency, no vertigo. Treatment should focus on Deficiency, considering the branch.

Headache and vertigo have Deficiency/Excess distinctions. *Neijing* clarifies: "Headache and vertex disease, Upper Excess Lower Deficiency, causes Jue vertex disease." This is because pathogens are above, causing pain, hence Upper Excess. For vertigo, it says "Upper Qi insufficiency" and "Upper Deficiency causes vertigo," never mentioning Upper Excess. Is vertigo not an Upper Deficiency syndrome? Why do some authors claim Qi rebellion creates Lower Deficiency and Upper Excess, contrary to *Neijing*? Vertigo symptoms include heaviness, blackouts, or brain spinning, unable to move. Seeking reasons for "Excess," people cite heaviness. But the head is not heavier than usual; it is simply unable to bear the weight, feeling heavier than before. Upper weakness is Yang Deficiency, not Upper Excess.

However, vertigo varies in severity. People with weak constitutions, or due to fatigue/alcohol/sex, may experience sudden tinnitus like grinding, vertigo, and blackouts, resolving quickly. This is common. After middle age, fainting and collapse are common. Quick resolution is "eye vertigo"; collapse without waking is "Stroke" or "Phlegm Stroke." Quick resolution means Qi and Blood are not ruined, hence transient; this is minor Stroke. Severe collapse means root is depleted, hard to recover; this is major vertigo. Observing this reveals whether it is Wind or Phlegm, Deficiency or Excess.

Although vertigo is Upper Deficiency, it relates to the Lower. Upper Deficiency is Yang within Yang Deficiency; Lower Deficiency is Yang within Yin Deficiency. Yang Deficiency treats Qi with Sijunzi Tang, Yigong San, Guipi Tang, Buzhong Yiqi Tang. Yin Deficiency supplements Essence with Zuogui Wan, Yougui Wan, Siwu Tang. Thus, damaging the lower withers the upper; nourishing the shoot irrigates the root. Supplementing Qi and Blood is best. Clear Fire if present, resolve Phlegm if present, regulate Qi if needed. Adapt to circumstances, but always prioritize treating Deficiency.